A Question of Abuse

In Reply: We thank Dr. Good for raising the crucially important issue of whether current clinical practice is more likely to exaggerate or underestimate prevalence rates of child abuse. Research suggests that the latter is far more likely than the former. In studies asking psychiatric patients about child abuse, the percentage of abuse disclosed to the researchers that had been identified by clinicians is alarmingly low, ranging from 0 to 30 percent (1).

A survey of users of mental health services found that 65 percent disclosed abuse to the researcher, but only 21 percent of this group had been asked about abuse at assessment (2). Even when inpatient admission forms include a specific section for abuse history, only a third of patients are asked about abuse (3).

Dr. Good offers no research evidence to support his suggestion that reports of possible abuse might later be translated into definite cases. Indeed, the available research suggests the opposite. For example, a recent study of 200 community mental health center (CMHC) outpatients found that 58 cases of abuse noted in previous files, which were attached to the current files, failed to produce any mention whatsoever of that abuse in the notes of the current CMHC clinicians (4).

There is also no evidence for the pervasive, and damaging, belief that psychotic patients are more likely to make false or imagined abuse allegations. Reports of abuse by people with a diagnosis of schizophrenia are as reliable as those made by the general population (5). The available evidence suggests that psychiatric inpatients underreport rather than overreport abuse (1).